<html>
<head>
<title>Form Menjadi Agen Resmi mahkotakubah.net</title>
</head>
<body>
<form action='https://mahkota2.googlecode.com/svn/proses_contact.php' method='post'>
<table border=0 cellpadding=4>
<tr><td>Nama  	</td><td><input type='text' size='40' name='nama'></td></tr>
<tr><td>Alamat	</td><td><input type='text' size='40' name='alamat'></td></tr>
<tr><td>Negara	</td><td><input type='text' size='20' name='negara'></td></tr>
<tr><td>No.Telp	</td><td><input type='text' size='20' name='No.Telp'></td></tr>
<tr><td>E-mail	</td><td><input type='text' size='40' name='email'></td></tr>
<tr><td>Pesan</td><td><textarea name='pesan' cols='40' rows='10'></textarea></td></tr>
<tr><td colspan=2><input type='submit' value='KIRIM'></td></tr>
</table>
</form>
</body>
</html>